Physician Assistant Billing | Presented by: Benjamin Schoen April - PowerPoint PPT Presentation

Physician Assistant Billing | Presented by: Benjamin Schoen April 6 th , 2017

Physician Assistant Practice Act of 1987 (225 ILCS 95/) The practice of utilizing a Physician Assistant in the State of Illinois is meant to encourage and promote a more effective utilization of the physician’s skills thereby enabling them to delegate certain health tasks to Physician Assistants where such delegation is consistent with the health and welfare of the patient and is conducted at the direction of and under the responsible supervision of the physician. 2

"Physician Assistant" means any person who has been certified as a Physician Assistant by the National Commission on the Certification of Physician Assistants or equivalent successor agency and performs procedures under the supervision of a physician as defined in this Act. A Physician Assistant may perform such procedures within the specialty of the supervising physician, except that such physician shall exercise such direction, supervision and control over such Physician Assistants as will assure that patients shall receive quality medical care. "Supervising Physician" means, for the purposes of this Act, the primary supervising physician of a Physician Assistant, who, within his specialty and expertise may delegate a variety of tasks and procedures to the Physician Assistant. Such tasks and procedures shall be delegated in accordance with a written supervision agreement. "Alternate Supervising Physician" means, for the purpose of 225 ILCS 95/, any physician designated by the supervising physician to provide supervision in the event that he or she is unable to provide that supervision. 3

Enrollment Requirements As per the ACA requirement, Physician Assistants are required to register with HFS as a Medicaid Provider in order to render services to Illinois beneficiaries and receive reimbursement. These providers should follow HFS guidelines to register and certify in IMPACT via IMPACT.Illinois.gov. Once registered, Physician Assistants are identified as Provider Type 089 on the HFS Provider Affiliation File sent weekly to MCOs. Eligible Physician Assistants (in good standing as actively enrolled) will be represented with “H” which stands for an Encounter Only Provider Type. 4

Managed Care Billing Requirements The managed care contracts between HFS and each of the MCOs provides the organizations flexibility in contracting with healthcare service providers when coordinating care with patients. Services supplied by Physician Assistants are allowed to be billed and reimbursed, either; 1) Directly, or 2) Under the supervising physician Physician Assistants are either enrolled with the Illinois Medicaid Assistance Program, or not rolled . 5

Physician Assistants Enrolled in the Illinois Medical Assistance Program Physician Assistants are allowed to bill and receive reimbursement directly when serving as the rendering provider so long as the Physician Assistant is registered in the Illinois Medical Assistance Program. To facilitate accurate Encounters submission in this scenario, MCOs require that performed services are to be billed with the enrolled Physician Assistant’s name and NPI as the rendering provider in box 24J of the CMS - 1500 claim form / Loop 2310B on 837p electronic submission or in box 56 of the UB-04 claim form / Loop 2310D on 837i electronic submission. 6

Physician Assistants Enrolled Example Provider Type NPI Jane Smith Physician Assistant 1922311111 John Doe, MD Supervising Physician 4581383333 John Doe Associates Provider Group 1922344444 Rendering NPI 7

Physician Assistants Not Enrolled in the Illinois Medical Assistance Program If the Physician Assistant is not registered in the Illinois Medical Assistance Program, they will be able to perform procedures under the care of a supervision of a Physician enrolled in the Illinois Medical Assistance Program per 225 ILCS 95/. To facilitate accurate Encounters submission in this scenario, MCOs require that performed services are to be billed with the enrolled supervising physician’s name and NPI as the rendering provider in box 24J of the CMS - 1500 claim form / Loop 2310B on 837p electronic submission or in box 56 of the UB-04 claim form / Loop 2310D on 837i electronic submission. 8

Physician Assistants Not Enrolled Example Provider Type NPI Jane Smith Physician Assistant 1922311111 John Doe, MD Supervising Physician 4581383333 John Doe Associates Provider Group 1922344444 Rendering NPI 9